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      In-hospital outcomes with anterior versus posterior approaches in total hip arthroplasty: meta-analysis of randomized controlled trials

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          The purpose of this study was to determine whether in-hospital outcomes are different with anterior approach (AA) or posterior approach (PA) in primary total hip arthroplasty (THA).


          We performed a systematic review with random-effects meta-analysis of random-ized controlled trials (RCTs) comparing AA with PA in primary THA. Hospital outcomes were reported as odds ratio (OR), weight mean difference, or standardized mean difference (SMD).


          A total of seven RCTs with 609 patients were included. Outcomes favoring AA included 1.4 cm shorter incision ( p=0.045), 0.5 days shorter hospital stay ( p=0.01), 0.5 points less pain on a 0–10 scale ( p=0.007), and less opioid use (SMD=−0.39 corresponding to 12 fewer morphine equivalents per day, p=0.01). The procedure time was 16 minutes longer with AA vs. PA ( p=0.002). There were no statistical differences between AA and PA in operative blood loss (mean difference =19 mL, p=0.71), transfusions (9.7% vs. 16.2%, OR=0.45, p=0.39), or complications (5.5% vs. 4.1%, OR=1.42, p=0.62).


          While the AA to primary THA may take longer time compared with the PA, the incision is shorter, and patients report slightly less pain, require less opioid medication, and leave the hospital earlier. The clinical relevance of these differences during longer-term follow-up is uncertain. The choice of surgical approach in primary THA should also consider factors such as experience of the surgeon and preferences of the surgeon and patient.

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          Most cited references 10

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          What is the learning curve for the anterior approach for total hip arthroplasty?

           Richard de Steiger (corresponding) ,  Michelle Lorimer,  Michael Solomon (2015)
          There are many factors that may affect the learning curve for total hip arthroplasty (THA) and surgical approach is one of these. There has been renewed interest in the direct anterior approach for THA with variable outcomes reported, but few studies have documented a surgeon's individual learning curve when using this approach.
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            The direct anterior approach in total hip arthroplasty: a systematic review of the literature.

             G Meermans,  S Konan,  R. Das (2017)
            The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of dislocation, faster recovery, reduced pain and fewer surgical complications. This systematic review aims to evaluate the current evidence for the use of this approach in THA.
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              Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a Direct Anterior or Posterolateral Approach: A Randomized Controlled Trial

              Controversy exists as to whether early functional outcomes differ after total hip arthroplasty performed using the direct anterior approach (DAA) or the posterolateral approach (PLA).

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                10 July 2018
                : 11
                : 1327-1334
                [1 ]Miller Scientific Consulting, Inc., Asheville, NC, USA, larry@ 123456millerscientific.com
                [2 ]Penn Medicine, Department of Orthopedic Surgery, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
                [3 ]Hospital for Special Surgery, New York, NY, USA
                [4 ]DePuy Synthes, Raynham, MA, USA
                Author notes
                Correspondence: Larry E Miller, Miller Scientific Consulting, Inc., 1854 Hendersonville Road, No 231, Asheville, NC 28803, USA, Tel +1 828 450 1895, Email larry@ 123456millerscientific.com
                © 2018 Miller et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.


                Anesthesiology & Pain management

                tha, systematic review, pain, opioid, complications


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